Originally published in Bay Area Parent magazine, "Free to Be Me: When kids dont fit traditional gender molds" received a Gold Award from Parenting Publications of America. This is what the judges said:

"This courageous article about gender-variant children serves the community by informing it about behaviors in a way that increases sensitivity and understanding. With careful and humanizing reporting, and a strong narrative component, these stories about children who want to make their own gender decisions at a young age become a compelling and informative read. "

Sabelle loves Barbies, Tinkerbelle and the feel of twirling around in a long skirt. With big brown eyes peering out from long blonde bangs, a sparkly pink-striped hoody and ribbon-laced High School Musical high tops, Sabelle seems like a typical 6 1/2-year-old girl.

But Sabelle was born Jack and still attends school as a boy. It is only after school that the Alameda first-grader trades in jeans and sweatshirts and emerges as Sabelle, the girl Jack has been trying to be since toddlerhood.

It started then with Jack putting sheets and pillowcases on his head, pretending he had long hair, his mom, Melinda, recalls. By 2 1/2, he began expressing discomfort with his male anatomy. I took him to the doctor and she said it was normal, that kids like to make believe. But I knew something was going on, Melinda says.

At 4, a friend made Jack a dress he refused to take off. Soon after, he started telling his mother that God had made a mistake, that he was really a girl. They returned to the doctor and were referred to a therapist who diagnosed Jack as gender-variant.

How can you deny it? asks Melinda, who recently started to allow Jack to dress as a girl in public and use the name Sabelle. This is who he is. He's a little girl.

A growing issue

The Alameda family is among a growing number of families grappling with the issues surrounding children who, at very young ages, are expressing that they do not fit traditional boy-girl gender molds. Some 35 families regularly attend a support group for families of gender-variant children at Childrens Hospital & Research Center Oakland. An annual conference for such families doubled in size in its second year last year.

Cross-gender kids are increasingly popping up in the mainstream media, attracting the likes of Oprah and Barbara Walters. And more and more schools, both private and public, are making accommodations, from providing staff and parent training to opening gender-neutral bathrooms.

There are no hard numbers on how many children are gender-variant, meaning their interests and behaviors fall outside what is considered normal for their biological sex. Cross-gender or transgender youth, who strongly and persistently identify as the opposite gender, are considered rare. But the number being allowed to live as the opposite gender at a young age is on the rise.

I dont think gender-variant or transgender children are more common (than they were in past decades), but parents are allowing them to express themselves more freely, says Stephanie Brill of Orinda, co-author of The Transgender Child A Handbook for Families and Professionals, believed to be the first book of its kind when it was published last year. Both pediatrics, in terms of medicine, as well as parenting approaches are valuing what children have to say about themselves. Its more commonplace now, when it was virtually unheard of in the past.

Brill, a midwife and mother of four, founded the Childrens Hospital support group in 2002, as well as Gender Spectrum Education and Training, which runs the annual conference for families and provides training on gender diversity and sensitivity.

Boys who like dresses and tomboys

Experts like Brill are quick to point out that many children express gender diverse tendencies, and that thee are definitely double standards in our society.

As supportive as she is of children who are outside gender norms, Brill is quick to caution that a 3-year-old boy who likes to try on his mothers shoes is unlikely to be gender-variant, let alone cross-gender.

Its most likely just exploration and fun and play. We dont bat an eye if a girl wants to dress up as a policeman, but it makes people uncomfortable if a boy wants to wear a dress, she says. Just because a child plays another gender in a game doesnt mean theyre transgender, but if a child expresses some distress at any time around their gender, its time to pay attention.

Sue, a Hillsborough mother, says her 10-year-old daughter has always refused girls clothing, preferring baggy cargo pants and sports jerseys. At 3, she went to a princess party dressed as Harry Potter. As a young child, she was often mistaken for a boy.

Until recently, nearly all of her friends were boys and she opted to play baseball over softball.

But her daughter has never expressed that she wants to be a boy, and Sue, whose name has been changed, does not consider her gender-variant. She prefers tomboy.

For me, its a non-issue, she says. But it would be more difficult if she was a boy who wanted to dress as a girl. The social pressure would be a lot more challenging.

Thats probably why there are more parents of biological boys than girls in the Childrens Hospital support group.

Brill says that very few gender-variant children are transgender, but those who are often begin expressing it in preschool.

Too young to know?

Many people react with disbelief that a preschooler, or an even younger child, could know that their biological gender feels wrong. But, Brill says, we dont question it when a 2-year-old girl likes dolls and pink and adamantly says she is a girl. Perhaps more importantly, many transgender adults say they always knew from the time they were very young that something was amiss.

Dr. Herb Schreier, a child psychiatrist at Childrens Hospital Oakland, has worked with dozens of gender-variant children, starting a decade ago.

I certainly feel these children are born this way, he says. But Schreier says the medical community remains divided internationally, with some doctors and therapists continuing to view gender variance as a disorder that should be treated, with cross-dressing and cross-play discouraged.

Schreier, who co-founded Brills support group, disagrees, and is working to educate pediatricians most of whom receive little training on the topic in medical school about gender-variant children.

Both Brill and Schreier caution that gender variance is complex and often changes. Schreier says only 20 percent of children who say they are in the wrong body grow up to be transgender, though many do eventually identify as gay.

Its an important distinction. While children are aware of their gender at a young age, most dont know their sexual orientation or attraction until at least 10 or 11.

Living in two worlds

Heather, a South Bay mother, says that from a very early age, she assumed her son Taylor would grow up to be gay. (Their names have been changed at their request.)

He was never a typical boy, not overly rambunctious or physical. He always had a long attention span and attention to detail, recalls Heather. Taylor liked dolls and dresses and the color pink.

At 4, Taylor would try on his mothers clothes. At 6, he said he wanted girl clothes that fit, and then said he wanted to be a girl.

The family was one of more than 70 families to attend the Gender Spectrum Family conference last summer in Seattle, the first time Taylor, now 8, dressed as a girl in public. He has continued to use his same name, which is gender-neutral.

Before we went up, he thought he was the only one in the world, says Taylors aunt. He found out he wasnt, and just that alone was worth everything.

Like Sabelle, Taylor is still attending school as a boy and usually dresses as a girl at home, where there is one drawer of boy clothes and another of girls, along with three wigs, including a long blond Hannah Montana one. Necklaces and scarves are draped over the doorknob of the closet, which contains a puffy pink fur-trimmed vest and rose-colored ballerina costume, along with boy clothes in dark colors.

Taylor is matter-of-fact about straddling two worlds.

These are my girl clothes. These are my boy clothes, Taylor says, giving a bedroom tour. Reaching under the bed, he pulls out two sets of race cars, including hot pink Polly Pocket ones. This is where my boy race cars are, and this is where my girl race cars are.

Strain on families

But while Sabelles mother is hoping to make the switch at school soon, Taylor has been told hell have to wait until at least age 12 because his father, from whom his mother is divorced, opposes any gender non-conformity going as far as banning pink polo shirts and Heather fears she could lose custody if her ex-husband learns she is letting their son live part-time as a girl.

Its not like his dad doesnt love him. Hes fighting to do what he thinks is best for (Taylor), Heather says.

Brill says a childs gender variance is often hard on parents, particularly fathers.

I still mourn my son, says Melinda. My son is not my son anymore. Maybe he never was.

Initially, her husband didnt believe her when Jack started saying he wanted to be a girl because he never told his dad. Then one day, his father saw Jack looking in the mirror and talking to himself.

I am a girl. I just have different parts on the outside, Jack said at the time.

My husband said, He is who he is. Lets make this world tolerable for him, says Melinda. But he is terrified about what is going to happen to him in the future.

His fears are not unfounded. Transgender adults, while becoming more accepted by society, remain the target of harassment and violence. Transgender youth have not been spared, evidenced by the high-profile murder of Gwen Araujo, the transgender teen from Newark who was beaten to death in 2002 by four men who did not initially know she was biologically male.

As cross-gender children get older, parents also have to grapple with difficult decisions on whether their children should take hormone blockers to delay puberty and the biological changes, which can be psychologically traumatic and physically difficult to reverse. While still rare, some doctors advocate such a step, allowing a child to buy time and make it easier to transition to the other gender, which often involves taking hormones of the opposite gender. Sexual reassignment, or sex change, surgery generally is reserved for adults and usually involves a long process of hormones, therapy and living full-time as the opposite gender for a period of time.

Dangers of denial

But experts say there also are risks to pressuring children to deny or suppress what they believe is their true gender.

So many children go to an authority figure to give them advice, and they say, You cant be openly gay or move like that or dress like that. Its for their own safety, out of love, wanting them to have a good life, says Dr. Caitlin Ryan, director of the Family Acceptance Project at San Francisco State University. What they dont understand is that these reactions, which young people experience as rejection, have a high mental health cost for children.

Ryan has been researching the impact of family reactions on gay, lesbian, bisexual and transgender youth, the first major study of its kind. Her findings, recently published in the journal Pediatrics, show that youth who experience a high level of rejection from their families are 5.9 times more likely to be seriously depressed and 8.4 times more likely to attempt suicide. They also have a higher likelihood of using illegal drugs, having unprotected sex and contracting HIV and other sexually transmitted diseases.

But Ryan says she has seen remarkable changes in families once they realize their behavior could be jeopardizing their childrens well-being. The project also is working with San Francisco General Hospital on outreach to families of LGBT youth, particularly in minority communities. They are developing education materials and guidelines to distribute nationwide and beyond.

Families who do accept their childs gender expression also have to face reactions from their own families, friends, religion and their childrens schools, as well as self-doubt.

Its the people who should be supportive who arent: best friends, family. That hurts, says Melinda. My husbands best friend said, What did you do to make your kid turn out that way?

Her own faith as a Jehovahs Witness has also proved challenging because she believes God doesnt make mistakes an argument sometimes put forth by critics who say parents should treat their children as their biological sex.

Says Heather: Even now, I still question: Is it something I did?

But Brill says gender variance is a normal part of human expression that some people experience. It has nothing to do with culture, religion, upbringing.

That said, some places certainly are more tolerant of such differences. Both Heather and Melindas families moved to the Bay Area from the Central Valley because they thought it would be safer and easier for their children to be different.

But that doesnt mean its easy.

Its a difficult situation, one I would never wish on a parent, Melinda says. But I would never change Sabelle. What am I going to do, love him less?

RESOURCES

Books

The Transgender Child: A Handbook for Families and Professionals, by Stephanie Brill and Rachel Pepper, Cleis Press Inc., 2008.

Read an interview with San Francisco author Marcus Ewert, author of 10,000 Dresses, featuring a gender-variant boy -- the first children’s book of its kind.

Schools tackle gender identityAs more families are allowing their children to express gender non-conformity, schools are facing issues from what to do if a boy wants to wear dresses to how to handle a girl who wants to enroll as a boy.